TAA 17. Novel Technique for Open Repair of Type III Thoracoabdominal Aortic Aneurysm Results in Less End-Organ Ischemia: No Bypass Shunt, No Perfusions, and No Hypothermia Techniques
Open repair of type III thoracoabdominal aneurysms (TAAs) remains a surgical challenge in view of massive dissection and secondary visceral, renal, and limb ischemia during surgery. A novel approach with two-bifurcated graft technique (to reduce visceral, renal, and limb ischemic complications) is reported.
CONCLUSIONS: Concomitant upper body perfusion by the transapical aortic approach contributes to avoidance of brain and heart complications and maintaining spinal cord circulation under deep hypothermic DTAA/TAAA surgery. PMID: 31640318 [PubMed - as supplied by publisher]
Four decades ago, surgical repair of thoracoabdominal aortic aneurysm (TAA) was one of the biggest challenges in cardiovascular surgery.1 Apart from in-hospital mortality, spinal cord damage (SCD) was the most dreaded complication.1 In the meantime, much progress has been made, and the pathophysiology of SCD is now much better understood. Different approaches have been developed to protect against SCD, such as distal perfusion, staged clamping, hypothermia, and cerebrospinal fluid drainage.2,3 Reattachment of intercostal arteries is believed by some to be the most critical intervention,2,3 even though this has been discussed controversially.
ConclusionsHybrid aortic arch and FET repair with the Thoraflex hybrid graft appears to be associated with good clinical outcomes, despite being early in the learning curve with this graft. Further investigation with this device is warranted to establish its role within the variations of hybrid arch repair.
CONCLUSIONS: Hybrid aortic arch and FET repair with the Thoraflex hybrid graft appears to be associated with good clinical outcomes, despite being early in the learning curve with this graft. Further investigation with this device is warranted to establish its role within the variations of hybrid arch repair. PMID: 30291835 [PubMed - as supplied by publisher]
Open surgical repair remains the gold standard operation for thoracoabdominal aortic aneurysm (TAAA). Contemporary surgical approaches balance the need to maximize long-term benefit by replacing as much diseased aorta as possible with limiting ischemia-related risk to the spinal cord and other organs. Despite the formidable challenges that extensive aortic replacement entails, excellent outcomes and a durable repair can be achieved at experienced centers. Here, we describe in detail our current approach to open TAAA repair, which includes providing spinal cord and end-organ protection by the use of surgical adjuncts such a...
CONCLUSIONS: We found no RCTs that compared controlled hypotension and normotensive resuscitation strategies in the management of haemorrhagic shock in patients with ruptured abdominal aortic aneurysm that assessed mortality, presence of coagulopathy, intensive care unit length of stay, and the presence of myocardial infarct and renal failure. High quality studies that evaluate the best strategy for managing haemorrhagic shock in ruptured abdominal aortic aneurysms are required. PMID: 29897100 [PubMed - as supplied by publisher]
Spinal cord injury leading to permanent paralysis continues to be a morbid complication of open thoracoabdominal aortic aneurysm (TAAA) repair. Several strategies have been suggested for spinal cord protection during TAAA repair, including mild passive hypothermia, cerebrospinal fluid drainage, left heart bypass, and reimplantation of the intercostal arteries.1 Various techniques have been described for reimplantation of the intercostal arteries, with emphasis on improved graft patency, yet the optimal strategy for reimplantation is still unknown.
Abstract Objectives Abdominal compartment syndrome (ACS) is poorly identified in surgery for ruptured abdominal aortic aneurysm and an early management is crucial. The aim of this study was to validate how many risk factors were needed to predict ACS. Secondary objectives were to assess its prevalence and the 30-day mortality. Methods All patients operated for ruptured abdominal aortic aneurysm during 5 years were included. An independent committee performed a retrospective diagnosis of ACS. Eight criteria were selected from the literature, and corresponded to pre- and intraoperative period: anemia (hemoglobin low...
Antegrade cerebral perfusion in aortic surgery is a well-established brain protection method. Open distal anastomosis during aortic surgery has some well-known advantages. Antegrade cerebral perfusion provides repair to some extent for the aortic arch even in isolated ascending aortic aneurysm. The present study aims to investigate adequate contralateral perfusion with novel oxidative stress parameters during unilateral antegrade cerebral perfusion.
Publication date: Available online 20 August 2016 Source:Best Practice & Research Clinical Anaesthesiology Author(s): Kak Khee Yeung, Menno Groeneveld, Joyce Ja-Ning Lu, Pepijn van Diemen, Vincent Jongkind, Willem Wisselink Open surgical repair of an aortic aneurysm requires aortic cross-clamping, resulting in temporary ischemia for all organs and tissues supplied by the aorta distal to the clamp. Major complications of open aneurysm repair due to aortic cross clamping include renal ischemia-reperfusion injury and postoperative colonic ischemia in case of supra- and infrarenal aortic aneurysm repair. Ischemia-reperfus...